Client Self-administration of Medication Assessment

Client Name

First NameLast Name

DOB

Date

Caring Lotus Staff Member

Caring Lotus Staff Member Name

Assessment Question?

	Yes	No	Comments
Does the participant wish to self-medicate?
Has the participant discussed the choice to self medicate with their family, if appropriate?
Was the participant self-medicating previously?
Was the participant using a dose administration aid previously?
Is the participant orientated in time and place?
What is the participants mini-mental exam score?
Does the participant have a history of alcohol or drug abuse?
Does the participant have any cognitive disabilities?
Does the participant have gross/fine motor skills deficit?
Is the participant able to communicate effectively?
Is the participant able to communicate effectively?

Can the client open the following?

	Yes	No	Comments
Bottles with normal lids
Bottles with child resistant lids
Foil packets
Boxes
Dose administration aids

Medication Questions

	Yes	No	Comments
Is suitable space provided for their medicines to be stored securely?
Can the participant unlock and open the drawer in which their medicines would be stored?
Can the participant read the labels on their medicines?
Does the participant understand what the medicine is for?
Does the participant know what to do if they miss a dose?
Does the participant know what to do if they take the wrong dose?
Can the participant identify the medicine?
Can the participant prepare the correct amount of medicine?
Can the participant administer eye/ear drops or ointment?
Can the participant administer their insulin? Has the participant been assessed as competent?
Can the participant apply and remove their own patches?
Can the participant administer inhaler devices correctly?

A No answer to any of the above questions indicates that the participant may not be competent to safely manage their medicines.

Are there any strategies which may assist the participantself-administer?

YesNo

Please list these Strategies

Did the assessment demonstrate that the participantis capable of self-administering their medicines safely?

YesNo

If Yes, complete the Participant Self Medication Indemnity Form.

If No, discuss the issues with the participant. If they insist on self-medicating, ask the GP to arrange a case conference with the participant and family to discuss the risks.

Acknowledgement that this decision was made in consultation with the participant or participant representative

RN Signature

Type a question

	Nurse Comments	GP Comments	Nurse / GP Comments
Initial Assessment
3 Monthly Review
6 Monthly Review
9 monthly review

Note: A participant’s ability to self-administer medicines should be reviewed more often if their medical condition changes or they are hospitalised.

Self-administration of Medication Assessment

Strategies

Assessed Safety